Risk factors of cardiovascular disease and its recommendations in Pakistani context.

Cardiovascular diseases possess a major cause for fatality and disability the world over. Since last several decades, the rates of cardiovascular diseases-related deaths have decreased in a number of high-income countries but increased in low- and middle-income countries with around 80% of the burden. Despite the seriousness of cardiovascular diseases in low- and middle-income countries, minimal attention is given to the prevention of cardiovascular diseases risk factors in South Asia, particularly in Pakistan. In addition, economic and political instability is accelerating the rates of cardiovascular diseases in the country. Practical efforts are required to enhance the understanding of cardiovascular diseases risk factors such as diet, physical activity, and tobacco-control policies to support prevention and control at the population level. This paper reviews the major modifiable risk factors in Pakistan, highlights available preventive services, and presents the most likely ways to promote risk-factor reduction

Coronary artery bypass grafting: Quality of life of patients in Karachi

In the Third World, cardiac Patients often suffer not only from the nature of their illnesses, but also the insufficiency of the facilities available. Although the effectiveness of coronary artery bypass grafting (CABG) is being evaluated in terms of mortality, complications or recurrence of symptoms, empirical studies assessing the change in Patients\u27 quality of life (QOL) after CABG within the Pakistani cultural context are lacking.Aims: The aims of the present study are to assess and compare the change in health-related quality of life before and 1 month after CABG and to assess the differences in QOL with respect to age, gender and cardiac rehabilitation programme attendance.Method: A prospective single group pre- and post-Study Design was used, whereby Patients completed a questionnaire before and 1 month after surgery. Questions considered the person\u27s physical capacity, psychological wellbeing, social relationships and satisfaction from their health condition.Results:The results indicated a significant improvement in Patients\u27 physical and psychological health, satisfaction with social relationships and overall health status. Younger Patients showed significantly lower scores on the social domain (reflecting greater dissatisfaction with their sex life and personal relationships). Female participants showed significantly lower scores in psychological health post surgery. Lastly, participants of the cardiac rehabilitation programme scored significantly higher in psychological health compared with non-participants.Conclusion: QOL improved from prior to and 1 month after CABG while differing (in specific domains) with respect to age, gender and cardiac rehabilitation programme attendance. The findings can be used to develop interventions to improve health and QOL in specific domains with respect to specific groups

School-based study to assess the nutritional status (BMI based) of adolescents of Gojra city of district Toba Tek Singh, Punjab, Pakistan

Adolescence is the make-or-break stage of life. Major physical, mental, and psychological growth takes place at this age. Adequate and balanced nutrition is a vital requirement to support this phase. Adolescents living in developing and low-income countries are more likely to face nutritional challenges. Poor nutritional status during adolescence is an important determinant of health outcomes.Objective: To analyze the nutritional status (BMI based) of school-going adolescents in Gojra city, Punjab, Pakistan. Methods: A school-based cross-sectional survey was carried out covering 635 (6-8 grade) school-going adolescents (boys and girls) from public schools in Gojra city. Data were collected through anthropometric measures taken. Symptoms of malnutrition were also assessed. Mean and frequencies were reported for demographic variables and symptoms of malnutrition while two sample Independent T-test was used to compare the means of groups under study using SPSS version-23.Results: The overall prevalence of underweight in boys was found (33.9%) as compared to adolescent girls (32.3%). It was also found that malnutrition and related health complications were higher in adolescents with lower BMI values.Conclusions: Adolescent boys and girls were found with a high prevalence of malnutrition along with other symptoms

Effectiveness of implementation of standard clinical pathway through healthcare professionals among acute myocardial infarction patients undergoing angiography / angioplasty in a public tertiary care hospital, Karachi

Objective: To assess the effect of acute myocardial infarction standard clinical pathway among acute myocardial infarction patients on length of stay in public tertiary care setting.Methods: The quasi-experimental non-randomised study was conducted at the Department of Cardiology, Dr Ruth Pfau Civil Hospital, Karachi, from September to December 2018, and comprised acute myocardial infarction patients. Those admitted before the implementation of acute myocardial infarction standard clinical pathway formed the control group, while those admitted after the implementation were in the intervention group. Acute myocardial infarction standard clinical pathway was implemented and the interventional clinical practices of healthcare professionals, including cardiologists, postgraduates, residents, nurses and critical care technicians, were assessed using a standard checklist. Data was analysed using SPSS 21.Results: Of the 100 participants, 50(50%) were in the control group; 31(62%) males and 19(38%) females. The intervention group also had 50(50%) patients; 35(70%) males and 15(30%) females. Regarding effectiveness of the implementation of standard clinical pathway, length of hospital stay reduced significantly in the intervention group compared to the control group (p=0.003).Conclusions: The implementation of acute myocardial infarction standard clinical pathway reduced the length of hospital stay of acute myocardial infarction patients

Burden of care as perceived by informal caregivers of the patients receiving chemotherapy in tertiary care hospital of Karachi, Pakistan

Background: Almost 32.5 million people are diagnosed with cancer annually. The huge number of cancer patients with deteriorating health renders a far greater number of informal caregivers bearing the burden of care in different forms and magnitude. The main purpose of the study was to explore the types of burden perceived by the informal caregivers and the factors associated with the caregiving burden.Methods: A quantitative descriptive cross-sectional study design was adopted to answer the research questions from April to May 2016. Around 200 informal caregivers were recruited from one of the tertiary hospitals of Karachi, Pakistan. The modified ZBIS was used to collect data which was analyzed by using Chi-square test to find the associations between the demographic characteristics of informal caregivers and the perceived burden of care. Results: Findings of the study identified the employment status (P ≤ 0.020) and the religion of the informal caregivers (P ≤ 0.027) as significant, demographic variables. The functional level of care receivers was also found to be significant (P ≤ 0.002). The study also recognized four forms of burdens, with significant mean values, including financial (2.85), psychological (2.50), social (2.58), and physical (2.44). Most of the participants reported experiencing a moderate magnitude of burden, ranging from 40 - 60, on the scale of 0 - 80. Conclusion: The study highlighted four different forms of burdens, that is, financial, psychological, social, and physical, along with their associated demographic factors. Health care agencies and public health personnel should work with informal caregivers to reduce burden of care

Smoking cessation interventions in south Asian countries: Protocol for scoping review

Introduction: Unfortunately, like many other health risks, smoking rate has been on the rise in developing countries. Half of current smokers in the world reside in only three countries of Asia that include India. Many smoking cessation interventions that were developed and successfully implemented in the context of developed countries have not been equally successful in South Asia. Hence, there is a dire need of culturally relevant smoking cessation interventions. We propose a scoping review with objectives to explore the extent and nature of interventions for smoking cessation and its associated factors in South Asian Region by systematically reviewing the available published and unpublished literature.Methods and analysis: The review has been registered in Joanna Briggs Institute (JBI) systematic reviews register and details are given in the Methodology section. The updated framework of JBI for scoping review methodology will be used as guide for conduct of this scoping review. Electronic databases (PubMed, CINAHL plus, Proquest Theses and Dissertations, EBSCO Dentistry and Oral Sciences, and Wiley Cochrane Library), reference lists of selected studies and grey literature will be considered for inclusion in this review. The literature search is anticipated to be carried out in December-January 2020. Initially, two reviewers in consultation with a librarian will develop search syntax followed by search from the selected sources. Consequently, the reviewers will screen all the titles, abstracts and full articles to establish relevance of each study for inclusion. Factors associated with smoking cessation will be coded and categorised applying qualitative content analysis, while interventions extracted from the literature will be described with the stated level of effectiveness

Knowledge and practices among nurses regarding patients’ care following cardiac catheterization at a tertiary care hospital in Karachi, Pakistan

Aims: The purpose of this study was to assess the knowledge and practices among nurses regarding patient care, following cardiac catheterization, at a tertiary care hospital in Karachi, Pakistan.Background: Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, globally. Nurses are the largest body of health care professionals who attempt to reduce the burden of cardiovascular diseases. Design: This study employed a descriptive analytical cross-sectional study design to answer the research questions.Methodology: The data were collected from 70 participants using two instruments. Knowledge was assessed through a 50-multiple-choice questions-based questionnaire, whereas, to assess the practices, an observational checklist was utilized which comprised of 20 components. Findings: The majority of the nurses, 54.3%, had adequate, 40% nurses had inadequate, and only 5.7% nurses had excellent knowledge scores. Moreover, 87.1% nurses were observed as carrying out unsatisfactory practices, whereas, only 12.9% nurses were found carrying out satisfactory practices.Conclusion: Since variation in the practices was observed in each of the department, therefore, there is a need for further research, to assess nurses’ attitudes through a qualitative approach and to develop and implement a standard post-cardiac catheterization care protocol

Adolescent food insecurity in rural Sindh, Pakistan: A cross-sectional survey

Background: Food insecurity (FI) is alarmingly high in developing countries including Pakistan. A quarter of Pakistan\u27s population consists of adolescents yet there is no information on their experience of FI. FI at adolescent age have long term effect on mental and physical health hence we aimed to determine the prevalence of food insecurity (FI) among adolescents and compare it with household FI, and assess social determinants of adolescent FI.Methods: A cross-sectional survey on 799 households with unmarried adolescents was conducted from September 2015 to June 2016 in three union councils of Hyderabad, Pakistan. Unmarried 10-19 years old girls and boys were interviewed regarding their FI status using Household Food Insecurity Assessment Scale (HFIAS). Household-level FI was also assessed by interviewing mothers of adolescents, and it was compared with adolescent\u27s FI. Association of adolescent\u27s FI with socio-demographic determinants was explored through Cox regression using STATA version 14.0. and prevalence ratios were estimated.Results: FI was found among 52.4% of the adolescents compared to 39% of the households. Thirty percent of the adolescents were food insecure within the food secure households. Female adolescents were found to be less food insecure (Adjusted Prevalence Ratio (APR) 0.4 95% CI [0.3, 0.5]) compared to males. Social determinants like socioeconomic status (SES), crowding index or education of parents were not associated with adolescents\u27 FI.Conclusion: Half of the adolescents were found to be food insecure which raises concerns regarding their health in the long run. Gender is an important social determinant of FI among adolescents which suggests an in-depth exploration of social dynamics of adolescent FI. We recommend the mixed-methods study to develop contextually relevant interventions to reduce FI among this group and improve their health status

Factors associated with postoperative pain among patients after cardiac surgery in the tertiary care teaching hospital of Karachi, Pakistan

Background: Pain is the subjective feeling of an individual, which affects the overall recovery of patients after cardiac surgery. Postoperative pain is the most inadequately managed symptom of cardiac surgery. Subsequently, there are many factors that can either hinder or facilitate pain management, including patients\u27 beliefs, cultural values, physiological features, hospital policies, and healthcare providers\u27 knowledge and beliefs. The purpose of this research was to identify factors associated with postoperative pain and its management, after cardiac surgery, among patients in a tertiary care hospital in Karachi, Pakistan.Methods: Quantitative correlational study design was employed to attain the study purpose. Data were collected from 136 adult cardiac surgery patients admitted in the Cardiothoracic Surgery (CTS) Department, of tertiary care hospital. A self-developed questionnaire tool was used to gather information from patients. Data was then analyzed on SPSS version 19. Mann-Whitney U, Kruskal Wallis, and Spearman tests were applied to find the associations between the pain levels and of the independent variables.Results: The mean pain scores of the first, second, and third postoperative days were found to be 2.98, 2.96, and 2.98, respectively. The findings also showed that BMI and the types of surgery were significantly associated with postoperative pain. Patients\u27 beliefs regarding drug dependency, fear of adverse effects, and postoperative physical activities were also associated with pain. Furthermore, the nurses\u27 education level and reluctance in medication administration due to fear of adverse effects were found to be significant too.Conclusion: The study identified some of the important factors that were associated with postoperative pain. The results suggest the need for the enhancement of patients\u27 education on drug dependency, adverse effects, and physical activity, before cardiac surgery. The nurses should be educated on pain management keeping the patients\u27 culture and other perceptions of pain in mind

Psychological distress and its associated factors among informal care givers of disabled young adults with traumatic brain injuries

Objective: To measure the psychological distress among the informal caregivers of disabled young adults with traumatic brain injuries (TBI) and to identify its associated factors.Methods: An analytical cross sectional study was conducted with 76 informal caregivers of young adults (19 - 50 years) with TBI, using admission records of one of the tertiary care hospitals in Karachi, Pakistan from 2015 to 2016. Data were collected using a structured questionnaire comprising a general demographic questionnaire and the General Health Questionnaire- 28. The effect of the predictors on the psychological distress was determined by applying multiple linear regression analysis.Results: The mean score of the psychological distress was found to be 23.5±14.28. The findings indicated that anxiety and insomnia, and social dysfunction were the most affected domains of psychological distress; whereas, depression was the least affected. Factors including the management of finances, number of children, patient\u27s gender, and patient\u27s level of disability and lack of socialization were positively associated with the level of distress. As reported by participants, religious beliefs served as a coping mechanism for most of them.Conclusions: The study showed a high level of distress among informal caregivers of young adults with TBI. For recognizing the psychological effects of TBI in patients and their informal caregivers, it is important to initiate and ensure the provision of psychological support to the patients and their families